Page 16 - GP Spring 2025

Clinical Presentation: shown promising results in reducing mor- five additional HPV strains (types 31, 33,
The 5-year mortality rate associated with bidity while maintaining favorable out- 45, 52, and 58).
oral cancer is particularly high due to ma- comes. 12
lignancies often being discovered late in its In 2018, the FDA expanded the age range
progression, which is why early detection 4. De-intensification Strategies: Given the and approved Gardasil 9 for men and
is so critical. favorable prognosis of HPV-positive oro- women ages 27 to 45. This approval was
pharyngeal cancer compared to HPV-neg- based on a study of women ages 27 to 45
When diagnosed at an early localized stage, ative OPC, de-intensification strategies are that showed an earlier version of the vac-
the 5-year survival rate is 83.7%; however, being explored to reduce long-term treat- cine was highly effective in preventing per-
when the cancer has metastasized at a later ment-related side effects. These include sistent HPV infection, genital warts, vulvar,
stage, the rate drops to 38.5%. According reducing the dose of RT or using less toxic vaginal, and cervical precancers, and cervi-
to one recent study, approximately 70% of agents like cetuximab instead of cisplatin in cal cancers related to virus types covered
cases are diagnosed at later stages. 8 selected patients. 13 by the vaccine (CITE).

Symptoms of oropharyngeal cancer may 5. Immunotherapy: Immune checkpoint It is important to note that if a person has al-
include a persistent sore throat, hoarseness, inhibitors such as pembrolizumab and ready been exposed to a particular strain of
earaches, swollen or tender lymph nodes, nivolumab are emerging as effective treat- HPV, the vaccine will not work against that
pain during swallowing, and unexplained ments, particularly for recurrent or meta- strain. Therefore, the sooner the vaccine is
weight loss. Often patients present without static HPV-positive oropharyngeal cancer. administered, the better. Even if somebody
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any symptoms at all which makes a thor- These agents target the PD-1/PD-L1 path- has already been exposed to a few strains,
ough oral cancer screening at dental ap- way and have shown efficacy in improving they can still gain protection against the
pointments critical to early detection. survival with potentially less toxicity. 14 strains they have not encountered.

Treatments: HPV Screening and Testing: CDC guidelines recommend that children
Currently, there are no treatments for HPV There are currently no FDA-approved tests ages 11 to 14 need only 2 doses of the vac-
infections. Fortunately, 9 out of every 10 specifically for screening HPV in the mouth cine. Those who are 15 to 45 will still need
infections will clear on their own within 1-2 or throat to detect HPV-related oral cancer. 3 shots, spaced a few months apart. The
years. However, it is not possible to know The U.S. Preventive Services Task Force
which infections will become chronic and (USPSTF) does not currently recommend vaccine is safe with most common adverse
possibly initiate dysplasia. Ideally, all ma- screening for oral HPV infection due to reactions being injection site pain, swell-
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lignancies are detected early, resulting in insufficient evidence on the accuracy and ing, redness, and headaches.
less invasive treatment, better treatment clinical utility of available tests.
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outcomes, and higher survival rates. In addition to vaccination, consistent and
The only way that head and neck cancers correct use of condoms and dental dams
The current treatment options for HPV-re- can be evaluated for the presence of HPV is can reduce the risk of HPV transmission.
lated oral cancer, particularly in high-inci- to biopsy the lesion and test it for the pres- Limiting alcohol and tobacco use may also
dence groups such as non-Hispanic white ence of HPV through DNA hybridization. help lower the risk of developing oropha-
males aged 65 years and older, include: Knowing whether malignancy was caused ryngeal cancers.
by HPV may help physicians determine
1. Concurrent Chemoradiation Thera- your prognosis for survival. Head and neck Conclusion:
py (CRT): The National Comprehensive cancers caused by HPV infection tend to re- Human papillomavirus plays a central role
Cancer Network (NCCN) recommends spond better to current treatments as com- in the initiation and progression of certain
concurrent systemic therapy with radiation pared to head and neck cancers caused by cancers, particularly oropharyngeal can-
therapy (RT) as the preferred treatment for tobacco or alcohol use. cer in men and cervical cancer in women.
newly diagnosed, very advanced HPV-re- Although there is no current diagnostic
lated oropharyngeal cancer. High-dose cis- Vaccination and Prevention: screening test or treatment for HPV infec-
platin is the category 1 preferred systemic Two vaccines, Gardasil and Cervarix, have tions themselves, vaccination has proven
antineoplastic agent due to its superior out- been manufactured and approved for use in effective in reducing the infection rate of
comes compared to cetuximab when com- the United States, however Cervarix was high-risk HPV strains when administered
bined with RT. 10 discontinued in 2016. The Food and Drug early. For those diagnosed with oropharyn-
Administration (FDA) approved Gardasil geal cancer, advancements in treatments,
2. Radiation Therapy (RT): Intensity- in the United States in 2006 for females including chemoradiation, minimally in-
modulated radiation therapy (IMRT) is aged 9 to 26. In 2007, the Advisory Com- vasive surgeries, and immunotherapy, have
commonly used to precisely target the tu- mittee on Immunization Practices recom- improved outcomes and reduced mortality.
mor while sparing surrounding healthy tis- mended Gardasil for routine vaccination of In the future, comprehensive public health
sue. This approach is particularly beneficial girls aged 11 and 12 and two years later, efforts, including vaccination campaigns,
in elderly patients to reduce treatment-re- the recommendation was expanded to also education on safe sexual practices, and reg-
lated toxicity. 11 include early adolescent boys. ular screenings for early detection, will be
vital to combating the impact of HPV and
3. Transoral Robotic Surgery (TORS): In 2014, the US Food and Drug Adminis- reducing the occurrence of HPV-related
TORS is a minimally invasive surgical op- tration (FDA) approved a nine-valent ver- cancers in the United States.
tion that can be used for resectable tumors. sion, Gardasil 9, to protect against infection
It is often followed by adjuvant therapy with the strains covered by earlier gener- All photos courtesy of the Dental Hygiene
based on pathological findings. TORS has ations of Gardasil (6,11,16,18) as well as Department of the New York City College
of Technology.
www.nysagd.org l Spring 2025 l GP 16